CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 4 4.000000 78.0400 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 58.7200 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 35.2400 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 115.6800 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 4.000000 84.1600 21.0400
EXIT-EXIT-COS Exit 1 0.750000 37.5000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.072533 455.4400 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 90.000000 6558.6300 72.8737
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 69.000000 5073.9400 73.5354
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 851.2400 70.9367
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 73.000000 4051.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 78.500000 4356.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 565.5100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 19 19.000000 976.7900 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 11.000000 514.1000 46.7364
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 308.4600 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 12 12.000000 616.9200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 7.000000 298.1500 42.5929
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 35 35.000000 1799.3500 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 37 38.000000 1922.3600 50.5884
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 26 125.000000 6014.9700 48.1198
Subtotal (Total Children Is Unduplicated) 355 707.822533 41411.7300 58.5058
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 4411.8800 1470.6267
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 14 40.000000 2000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 652 2557.250000 127644.5000 49.9148
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 87 202.000000 10100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 443 2084.750000 146890.3700 70.4595
OCCT-97530GT-OT SESSION BY LICENSED OT 22 55.750000 4011.7700 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 69 296.674131 16637.6000 56.0804
OCCT-97530HMGT-OT SESSION BY OT ASST 3 6.500000 374.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 470 2103.428849 148007.5100 70.3649
PHY-97110GT-PT SESSION BY LICENSED PT 14 29.750000 2140.8100 71.9600
PHY-97110HM-PT SESSION BY PT ASST 49 207.397672 11880.2500 57.2825
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 11.000000 633.1600 57.5600
SENS-V5264-EARMOLD 2 3.000000 54.3900 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 822 4268.263370 300339.5120 70.3657
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 47 172.750000 12254.2600 70.9364
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 13 71.250000 4104.0000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 4 23.250000 1339.2000 57.6000
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 4.000000 55.8400 13.9600
Subtotal (Total Children Is Unduplicated) 2120 12140.01402 792879.4520 65.3112
-----------------------------------------------------------------------------------------------------------------------
Total 12847.836555 834291.1820 64.9363
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Number of Children (Unduplicated) With at Least One Service 2313
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1338 1354.750000 74250.9000 74250.9000
D 49 49.000000 2713.5200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 904 909.000000 48357.8500 48482.2700
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2291 2312.750000 125322.2700 122733.1700
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 472 324.750000 23782.0300 23724.7700
46 28.000000 2014.8800 0.0000
Other 1 0.750000 53.9700 53.9700
---------------------------------------------------------
Total 519 353.500000 25850.8800 23778.7400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 16 16.500000 975.3400 975.3400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.000000 150.0000 150.0000
T 0 0.000000 0.0000 0.0000
209 257.500000 16460.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 228 277.000000 17585.3400 1125.3400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 34 71.000000 4596.0600 3976.1900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 3.500000 251.8600 0.0000
Other 136 292.000000 20521.0700 555.1300
---------------------------------------------------------
Total 171 366.500000 25368.9900 4531.3200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 64 61.000000 3763.4600 3763.4600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7 7.000000 503.7200 503.7200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 71 68.000000 4267.1800 4267.1800
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 281 233.250000 14904.3600 14904.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
257 212.750000 14216.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 538 446.000000 29120.4100 14904.3600
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 760 760.750000 53399.5500 53399.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 760 760.750000 53399.5500 53399.5500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 569 1948.000000 136566.6000 136554.6400
D 7 22.000000 1511.1600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
132 398.000000 28177.7100 0.0000
Other 6 11.000000 649.5000 0.0000
---------------------------------------------------------
Total 714 2379.000000 166904.9700 136554.6400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1265 2206.750000 149925.9600 149925.9600
D 2 2.500000 179.9000 0.0000
S 6 5.500000 128.9400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
856 1130.500000 77936.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2129 3345.250000 228171.0400 149925.9600
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 11 30.000000 1977.2000 1977.2000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3 12.000000 279.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14 42.000000 2257.1600 1977.2000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 645 675.000000 38239.1600 38239.1600
228 237.250000 15877.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 873 912.250000 54116.9400 38239.1600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 54 55.500000 4726.2100 4726.2100
111 115.500000 8081.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 165 171.000000 12807.8700 4726.2100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 338 347.140000 18607.0500 18607.0500
138 127.610000 7678.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 476 474.750000 26285.4200 18607.0500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 235 239.750000 16258.8400 16258.8400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
397 372.586555 24899.9020 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 632 612.336555 41158.7420 16258.8400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 11 8.104924 569.2400 0.0000
D 14 14.540857 960.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 48 58.000000 3859.7400 3859.7400
222 246.104219 16285.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 295 326.750000 21674.4200 3859.7400